A nationwide survey of adherence to analgesic drugs among cancer patients in Taiwan: prevalence, determinants, and impact on quality of life
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Poor adherence to analgesic drugs is one of the most common barriers to adequate pain management. This prospective, cross-sectional, patient-oriented observational study aimed to explore the adherence rate, clinical factors, and impact of adherence to analgesic drugs on the quality of life (QoL) among cancer outpatients in Taiwan.
Eight hundred ninety-seven consecutive adult outpatients with cancer who had reported tumor pain and received regular analgesic drug treatment were enrolled from 16 medical centers across Taiwan. The Brief Pain Inventory was used to assess pain intensity and QoL. Morisky’s four-item medication adherence scale was used to assess adherence to analgesic drugs. Clinical factors possibly associated with good adherence to analgesic drugs were analyzed using multivariate logistic regression analyses.
Of the 897 patients, 26.9% met criteria for the good, 35.5% for the moderate, and 37.6% for the poor adherence groups. The good adherence group had significantly better QoL outcomes than the moderate and poor adherence groups (all p < 0.05). Age ≥ 50 years, head and neck or hematological malignancies, cancer-related pain, patients who agreed or strongly agreed that the side effects of analgesic drugs were tolerable, and patients who disagreed or strongly disagreed that the dosing schedule could be flexibly self-adjusted to deal with the actual pain were predictors of good adherence to analgesic drugs.
Awareness of the clinical factors associated with adherence to analgesic drugs may help clinicians to identify cancer patients at a greater risk of non-adherence, reinforce optimal pain management, and improve the QoL by enhancing adherence to pain medications.
KeywordsCancer Pain Adherence Predictive factor Quality of life
Compliance with ethical standards
The authors gratefully acknowledge the assistance of the patients who participated in this study, and support grants from the Taiwan Society of Cancer Palliative Medicine and Johnson & Johnson.
Conflicts of interest
The authors declare that they have no competing interests.
- 4.Caraceni A, Hanks G, Kaasa S, Bennett MI, Brunelli C, Cherny N, Dale O, de Conno F, Fallon M, Hanna M, Haugen DF, Juhl G, King S, Klepstad P, Laugsand EA, Maltoni M, Mercadante S, Nabal M, Pigni A, Radbruch L, Reid C, Sjogren P, Stone PC, Tassinari D, Zeppetella G (2012) Use of opioid analgesics in the treatment of cancer pain: evidence-based recommendations from the EAPC. Lancet Oncol 13(2):e58–e68PubMedCrossRefGoogle Scholar
- 5.Ripamonti CI, Bandieri E, Roila F, ESMO Guidelines Working Group (2011) Management of cancer pain: ESMO clinical practice guidelines. In: Ann Oncol 22 Suppl 6:vi69–77Google Scholar
- 8.National Health Research Institutes and Taiwan Cooperative Oncology Group. Clinical guideline for management of cancer pain, 1st ed (2007). Miaoli County, Taiwan. Available at: http://www.nhri.org.tw/NHRI_ADM/userfiles/file/tcog/pain(2).pdf. Accessed 01 February 2018
- 10.Rau KM, Chen JS, Wu HB, Lin SF, Lai MK, Chow JM, Huang ML, Wang CJ, Tai CJ, Hwang WL, Lu YC, Chan CH, Hsieh RK (2015) The impact of pain control on physical and psychiatric functions of cancer patients: a nation-wide survey in Taiwan. Jpn J Clin Oncol 45(11):1042–1049PubMedPubMedCentralCrossRefGoogle Scholar
- 11.Shen WC, Chen JS, Shao YY, Lee KD, Chiou TJ, Sung YC, Rau KM, Yen CJ, Liao YM, Liu TC, Wu MF, Lee MY, Yu MS, Hwang WL, Lai PY, Chang CS, Chou WC, Hsieh RK (2017) Impact of undertreatment of cancer pain with analgesic drugs on patient outcomes: a nationwide survey of outpatient cancer patient care in Taiwan. J Pain Symptom Manag 54(1):55–65CrossRefGoogle Scholar
- 29.Zhang H, Singer B (1999) Recursive partitioning in the health sciences. In: Analysis of censored data: survival trees. Springer, New York, pp 93–104Google Scholar